P55 MULTIPLE MYELOMA AND SARS-COV-2 INFECTION: AN EUROPEAN HEMATOLOGY ASSOCIATION SURVEY (EPICOVIDEHA) OF 1,221 PATIENTS THROUGH THE DIFFERENT PHASES OF COVID-19 PANDEMIC
Authors: P. Musto, J. Salmanton-García, N. Sgherza, R. Bergantim, F. Farina, A. Glenthøj, G.C. Seval, B. Weinbergerová, V. Bonuomo, Y.M. Bilgin, L. Rahimli, F. Marchesi, O.A. Cornely, L. Pagano
Journal: HemaSphere (2023)

Patients with multiple myeloma (MM) appear particularly vulnerable to SARS-CoV-2 infection due to compromised humoral and cellular immunity and to anti-tumor treatments. The aim of this multicenter, observational study was to describe and analyze the outcome of a large number of MM patients with COVID-19 during the different phases of the pandemic. We enrolled 1,221 MM patients with confirmed SARS-CoV-2 infection between February, 2020 and August,2022, reported in the EPICOVIDEHA registry, an international, web-based, open platform for patients with hematological malignancies infected with SARS-CoV-2. The median age was 68 years (range: 30-95), with a male predominance (57.5%). Eight-hundred-eleven patients (66.4%) had at least one underlying comorbidity, mostly a cardiovascular disease. At the time of analysis, only 414 patients (34%) resulted vaccinated with 1 or more doses (mainly 3). Concerning MM status, 793 patients (64.9%) had controlled/stable disease while in 390 cases (31.9%) MM was active, including 56 newly diagnosed subjects. Regarding last MM treatment before SARS-CoV-2 infection, most patients had received chemotherapy (57.2%) or immunochemotherapy (20.2%) while, about transplant setting, 61 patients had received autologous-HSCT, 2 patients allogenic-HSCT, 4 patients CAR-T cell therapy. At COVID-19 onset, 728 patients (59.7%) had respiratory/pulmonary symptoms, 224 (18.4%) exhibited only extra-pulmonary symptoms and 269 (22%) were asymptomatic. COVID-19 was critical in 169 patients (13.8%), severe in 471 (38.6%), mild in 350 (28.7%), and asymptomatic in the remaining cases (18.9%). Four-hundred-forty-six patients (36.5%) were confined at home and managed as outpatients during SARS-CoV-2 infection, while 775 patients (63.5%) were hospitalized. One-hundred-sixty-nine patients (13.8%) were admitted to an intensive care unit (ICU) and 63.3% of them required invasive mechanical ventilation. No specific pharmacologic treatment for COVID-19 was reported in 270 patients (22.1%), while in 346 (28.3%) it included various combinations of antivirals, monoclonal antibodies, corticosteroids and convalescent plasma. With a median follow-up of 52 days (range: 0-763) for the entire cohort and 83.5 days for survivors, 303 patients died (total mortality rate: 24.8%). The reported primary reason for death was COVID-19 in 196 (64.7%) patients, a combination of MM and COVID-19 in 72 (23.8%) and a combination of MM and other reasons in 35 (11.5%). Overall survival (OS) was significantly higher in vaccinated patients with both stable and active MM versus not vaccinated ones (p=0.002 and p=0.003, respectively). At multivariate Cox regression analysis, age (p=0.001), renal failure (p=0.001), active disease (p=0.001), hospital admission (p=0.001), and ICU admission (p: 0.001) were also independently associated with poor survival. A time-dependent analysis revealed that mortality rates progressively reduced throughout the different pandemic waves, from 34% (first wave) to 10.2% (last wave) (Figure 1). The overall improvement realistically reflects a combination of factors, including novel targeted treatments for symptomatic patients, improved healthcare experience dealing with this type of patients, different severity of the dominant COVID-19 variants of concern, detection of a larger number of asymptomatic/mild cases by screening programs and, above all, extensive vaccine policies.